KH: What kind of timeframe are you looking at for this?
GC: The plan right now is for us to roll in out in chunks. We have pieces of it available now. That overarching piece of software, which some people want to call middleware or service-oriented architecture, that connects all the different components and brings them together to you when you’re buying the vitamins or using the concierge, is something that doesn’t exist today. We’re presently working with one other health system that has similar beliefs with ours, and beginning to try to formalize our design specifications to take that out to the industry to talk to big vendors about developing that software for us.
You’re hearing rumblings of this type of stuff when you hear people talk about integration, service-oriented architecture, middleware, stuff like that. But truly what needs to be done isn’t in the sights of anyone that’s developing any of this stuff. What really needs to be out there isn’t just the ability to integrate, but to parch through the information. It’s easy to put a patient’s information out on a portal, but if I’m a doctor who is only concerned about your liver, I don’t need to see the other tens of thousands of pieces of information I might have about you.
If I’m your primary care physician, I do care about all the information, but I can’t handle it all. I need tools that help me parch through that information and make it meaningful. That set of tools is just not out there today.
KH: Right, and that’s certainly something a lot of people would definitely value. You seem to have a very full plate at Christus. Has it been this way since you began your term as CIO? Have things always moved at this pace at Christus?
GC: Well, yes. Initially it was the combining of two organizations that had common roots but had evolved in very different directions — my job was to get them to work together and get people talking. Dr. Royer (Christus CEO Tom Royer), from day one, hammered on consistency and predictability in the organization; he created the concept of our balanced scorecard. If you’ve been on our Web site, you’ve seen what we’ve got out there from a transparency perspective. We’ve almost always had our financial information out there, but we now also have clinical, patient quality and safety information out there on the Web, as well as our community benefit. We’re one of very few organizations that has been that transparent for so long. So that was another step for us.
There’s a famous bumper sticker down here that says something like, ‘you’ll have to peel my 357 Magnum from my cold dead hands’. Prior to 2004, that was the attitude of some people relative to their vocal operations, including their information systems. One of our regional CEOs (at the time) even said that; he was very clear, he said, you’re going to peel my McKesson system out of my cold, dead hands. In 2004, the organization reached a tipping point and leadership came to us and said, what would it take for us to move to a single information systems platform? We said that it would take this amount of money. But to do it right and to get the benefit out of spending that money, what we would need to do is standardize a lot of what we’re doing.
So we put teams at work for almost nine months on generating a new business and clinical model for Christus. They standardized over 500 business and clinical practices across the organization, literally tens, if not hundreds of thousands of data items were standardized across the organization. Then, we started to put that into the Meditech system, which is what we decided to go with, and install it all across all of Christus. So 2004 was a real tipping point for us and ever since then, any new system that we’ve purchased is heavily scrutinized for its ability to be able to play fairly in this integrated framework.
KH: That’s very smart, especially considering everything you went through to standardize your data.
GC: Exactly. When I first started here, one of our hospitals had three different physician credentialing systems. One in medical records, one in the physicians’ office and one that was part of the core HIS. And we had to have interfaces between all three of those systems. So it was nonsense when that same region complained about how much work it took and how long it took to get new functionalities out; my response was, that is your fault, not mine. From 1999 forward, we’ve been adamant about creating standards and moving towards standards.
I spoke with Vi Shaffer, who is an analyst at Gartner, Inc., about the hype cycle, and we got to a conversation about centralization. She said that big companies are realizing that this discussion about centralization, consolidation and standardization is the wrong conversation; the conversation needs to be about community, and how do you create community within an organization. How do you create a single face to your customers and your users, and that’s what it needs to be about.
Her use of the word community was interesting in two respects. One, I was trying to find a word to say that to people, because centralization, consolidation and standardization wasn’t what it was about. Secondly, we are a Catholic organization, and Catholic organizations are typically founded by congregations of sisters who call themselves communities. So the use of that word fits in very well from a cultural perspective, as well as from a practical and understanding perspective.
There’s another organization that I’m joining now called the Center for Information Systems Research at MIT (Sloan School of Management), which is run by Dr. Peter Weill. Dr. Jeanne Ross, one of his associates, is taking over. We had a similar conversation at their summer meeting, and one example they used is Johnson and Johnson. Johnson and Johnson has something like 127 operating companies under their umbrella, and sometimes organizations like ours are doing business with 50 or 60 of those companies. The interface with every one of those 50 or 60 companies was different; the billing was different, the product standardization and numbering — everything was different from one company to the next. And it was driving customers crazy. But Johnson and Johnson had prided itself on the independence of its operating units and its customer satisfaction. So they went out to customers and asked what they didn’t like, and they were told that what they didn’t like was exactly what Johnson and Johnson did like about itself, which is the independence of its operating entities. They’ve now pushed significant customer-facing standardization. What they do within the company to keep the independence and creativity up, while it’s important to customers, it’s not something they necessarily need to know about. But it is a pain in the neck to have to deal with that many different companies. I’ve had the same conversation with GE.
That creation of community requires a creation of standards, and it’s something that fits very well with us. As we roll systems out now, we look at how they’re going to fit within the community; how are they going to create continuity of care, and provide us with not just competitive advantage. But because we believe also in community-based healthcare, how do we leverage the services we can offer to communities to help provide better community-based care, which means, in some cases, working with our competitors. How do we open our doors and be transparent to them?
KH: From the consumer’s standpoint, it’s great to hear that Christus is willing to work with competitors to provide patients with better care. You don’t always hear about situations like this.
GC: Well, you have to remember that it has direct implications for us. One of the basic tenets of capital healthcare is community return and community value. It’s a legal requirement for us to remain a not-for-profit institution under IRS rules, but more importantly for us, is that it’s part of our mission. We’re number one or two on a year-to-year basis amongst all the Catholic institutions in the country as a provider of charity care. We provided nearly $300 million worth of charity care last fiscal year, and we’re on track for the same this year. But $300 million out of a net operating revenue of $2.75 billion is a pretty big chunk of that number. We’re about two to two-and-a-half times the federal rule for maintaining our not-for-profit status, and that’s uneven across the organization because each community is measured separately. But on the average, that’s what we’re doing and that’s a big amount of money, and a lot of that money comes in care provided to patients in our emergency rooms.
An emergency room is the worst place for a patient to be treated because it means, in essence, that the community has failed in its obligations to its citizens. But it also ties up a huge chunk of very expensive floor space within a hospital. So part of our goal in all of this is to create these community initiatives or partnerships with the other charitable institutions in communities — our competitors in some instances — to build clinics either under own our aegis or the community entities’ aegis or through the federally-qualified healthcare plans structures, and get federal funding to deliver services. Our experience has been rapid and significant reductions in emergency room visits by patients.
We created an initiative called the medical home for patients and in association with the community health worker using the concierge services that we talked about. They keep an eye on the patient and say, you’re sounding like your diabetes might be kicking up. Have you been taking your pills? Have you been doing your tests? Have you had a glass of orange juice today, that kind of thing — to do the types of things to make sure patients don’t crash and end up in the emergency department.
So those initiatives, while they are, on the one hand, potentially problematic, they’re also needed from a community health perspective and also have a significant, demonstrable, positive impact on our costs.
KH: Is Christus receiving any other funding?
GC: Yes. Texas was a recipient of one of the FCC grants that were doled out last year, and Christus is the fiduciary for that grant. We’re working with the University of Texas, Texas A&M University and an organization called TORCH (Texas Organization for Rural and Community Hospitals), which is a consortium of regional hospitals. The first stage in this is we have to let an request for proposal for somebody to come back and help us design the network, and that’s where we are right now. But after that, our responsibility is going to be to create a non-for-profit corporation that will run this entity for the benefit of the population of Texas.
We’re also aligned, not in the same roll, with a similar project in Louisiana, which is where are two big centers of hospitals are.
What separates Christus from other organizations is that they have a bottom level is acute care institutional base, then they accrete other stuff on top of it like homecare and hospice and long-term care. Maybe they have a retail initiative and IT projects and doctors offices, but they accrete them layer upon layer, and there’s no real connection between the layers. It used to be that the hospitals funded all that stuff, and saw no benefit from it. That’s very different from the way we’re operating, where the whole goal is to connect all of these entities around the focus of the patient and the family and the community. What connects all these entities is data, and what makes that data valuable is the creation of standards and the creation of community in a design that we’re affecting here at Christus.
